“That's not my job”: A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health

Abstract

Introduction Home care (HC) aide is among the fastest‐growing jobs. Aides often work in long‐term care relationships with elders or people with disabilities in clients’ homes, assisting with daily activities. The purpose of this mixed‐methods paper is to elucidate aides’ experiences around the boundary‐challenging behaviors of clients asking for services beyond aides’ job duties and to identify possible interventions. Methods A cross‐sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post‐survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in‐depth interviews with HC industry and labor representatives. Results Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47‐2.52 for verbal, PR = 1.81; 95%CI: 1.13‐2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11‐2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89‐1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90‐0.98). Qualitative data showed that clients’ requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. Conclusion Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.

“It changed everything”: The Safe Home Care qualitative study of the COVID-19 pandemic’s impact on home care aides, clients, and managers

“…Qualitative analysis of the transcripts followed the grounded theory approach [31,32]. The computerassisted qualitative analysis process followed a technique similar to that utilized in earlier Safe Home Care Project qualitative and mixed-methods studies [1,21,33,34]. The phone interview transcripts were coded line-by-line into hierarchical themesup to 5 levelswith NVivo 12 software.…”

“…In the USA, care recipients can be called patients, clients, or consumers depending on the medical or social service system overseeing their care; in this paper, “client” refers to all care recipients [ 21 ]. There are many job titles for HC aides, based on their skillset and duties, for example, home health aide, personal care aide, personal care attendant, companion, and homemaker.…”

“…There are many job titles for HC aides, based on their skillset and duties, for example, home health aide, personal care aide, personal care attendant, companion, and homemaker. In this paper, the term “HC aide” or “aide” refers to all aide jobs [ 2 , 21 ]. HC aides are primarily women and increasingly people of color and immigrants [ 22 ].…”

Challenging Aggressive Behaviors Experienced by Personal Support Workers in Comparison to Home Care Workers: Relationships between Caregiver Experiences and Psychological Health

“…Differences in experienced aggression and psychological outcomes between HCWs and PSWs could point to potential buffering factors that are unique to personal support work, including job role expectations [8,25] and close personal relationships with the populations served [41]. For example, PSWs' prior knowledge and expectations for working with individuals with IDDs may cause them to expect challenging behaviors, and view management and coping with such behaviors as intrinsic to the job [8].…”

Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides

“…Aides who reported often being asked to do tasks outside their job duties were more likely to report both verbal and physical abuse and pain/injury with lost work time or medical care. These aides were also less likely to want to remain in their job or to recommend it to others [ 69 ]. A potential protective intervention was identified: aides having predictable work hours were less likely to report verbal abuse [ 68 ••].…”